Genome sequencing identify chromosome 9 inversions disrupting ENG in 2 unrelated HHT families

Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease, is a dominant inherited vascular disorder. The clinical diagnosis is based on the Curaçao criteria and pathogenic variants in the ENG and ACVRL1 genes are responsible for most cases of HHT. Four families with a negative targeted gene panel and selected by a multidisciplinary team were selected and whole-genome sequencing was performed according to the recommendations of the French National Plan for Genomic Medicine. Structural variations were confirmed by standard molecular cytogenetic analysis (FISH). In two families with a definite diagnosis of HHT, we identified two different paracentric inversions of chromosome 9, both disrupting the ENG gene. These inversions are considered as pathogenic and causative for the HHT phenotype of the patients. This is the first time structural variations are reported to cause HHT. As such balanced events are often missed by exon-based sequencing (panel, exome), structural variations may be an under-recognized cause of HHT. Genome sequencing for the detection of these events could be suggested for patients with a definite diagnosis of HHT and in whom no causative pathogenic variant was identified.

A Comprehensive Survey on Community Detection With Deep Learning

Detecting a community in a network is a matter of discerning the distinct features and connections of a group of members that are different from those in other communities. The ability to do this is of great significance in network analysis. However, beyond the classic spectral clustering and statistical inference methods, there have been significant developments with deep learning techniques for community detection in recent years-particularly when it comes to handling high-dimensional network data. Hence, a comprehensive review of the latest progress in community detection through deep learning is timely. To frame the survey, we have devised a new taxonomy covering different state-of-the-art methods, including deep learning models based on deep neural networks (DNNs), deep nonnegative matrix factorization, and deep sparse filtering. The main category, i.e., DNNs, is further divided into convolutional networks, graph attention networks, generative adversarial networks, and autoencoders. The popular benchmark datasets, evaluation metrics, and open-source implementations to address experimentation settings are also summarized. This is followed by a discussion on the practical applications of community detection in various domains. The survey concludes with suggestions of challenging topics that would make for fruitful future research directions in this fast-growing deep learning field.

Infection prevention for immunocompromised patients: A cross-translational multicentric survey of current organization in France

OBJECTIVES

To evaluate current organization of infection prevention for immunocompromised patients (ICP) at a countrywide level.

METHODS

Nationwide cross-sectional multicenter study based on an online survey disseminated in 2022 to physicians invested with preventive healthcare missions.

RESULTS

A total of 341 physicians (96% graduates, 32% infectious disease specialists), participated in the survey, with a median age of 40 [35-51] years. On-site access to infection prevention consultations for ICP was reported by 30%, dedicated pre-travel consultations for ICPs by 29%, consultations for infection prevention in solid organ transplant candidates by 16% and return-to-work consultations for ICPs by 6%. Most participants (73%) were aware of nationwide vaccination guidelines for ICP, while 50% felt comfortable using them. Tools for infection prevention advice and ICP vaccination had been developed by 10%, while 89% would have appreciated access to tools developed by others.

CONCLUSIONS

Infection prevention for ICPs remains neglected. Guidelines covering all fields of prevention for ICPs would be more than welcome.

News Coverage of Face Masks in Australia During the Early COVID-19 Pandemic: Topic Modeling Study

BACKGROUND

During the COVID-19 pandemic, web-based media coverage of preventative strategies proliferated substantially. News media was constantly informing people about changes in public health policy and practices such as mask-wearing. Hence, exploring news media content on face mask use is useful to analyze dominant topics and their trends.

OBJECTIVE

The aim of the study was to examine news related to face masks as well as to identify related topics and temporal trends in Australian web-based news media during the early COVID-19 pandemic period.

METHODS

Following data collection from the Google News platform, a trend analysis on the mask-related news titles from Australian news publishers was conducted. Then, a latent Dirichlet allocation topic modeling algorithm was applied along with evaluation matrices (quantitative and qualitative measures). Afterward, topic trends were developed and analyzed in the context of mask use during the pandemic.

RESULTS

A total of 2345 face mask-related eligible news titles were collected from January 25, 2020, to January 25, 2021. Mask-related news showed an increasing trend corresponding to increasing COVID-19 cases in Australia. The best-fitted latent Dirichlet allocation model discovered 8 different topics with a coherence score of 0.66 and a perplexity measure of -11.29. The major topics were T1 (mask-related international affairs), T2 (introducing mask mandate in places such as Melbourne and Sydney), and T4 (antimask sentiment). Topic trends revealed that T2 was the most frequent topic in January 2021 (77 news titles), corresponding to the mandatory mask-wearing policy in Sydney.

CONCLUSIONS

This study demonstrated that Australian news media reflected a wide range of community concerns about face masks, peaking as COVID-19 incidence increased. Harnessing the news media platforms for understanding the media agenda and community concerns may assist in effective health communication during a pandemic response.

Long-term follow-up of patients with extensive segmental infantile hemangioma of the cervical or facial region: A French single-center prospective study

BACKGROUND

Infantile hemangiomas (IHs) can be part of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies) syndrome when they are segmental, extensive, and located on the face or neck. The initial assessment is codified and well known, but there are no recommendations for the follow-up of these patients. The aim of this study was to assess the long-term prevalence of different associated abnormalities.

METHODS

Patients with a history of large segmental IHs of the face or neck. diagnosed between 2011 and 2016 were included in the study. Each patient underwent an ophthalmological, dental, ENT (ear, nose, and throat), dermatological, neuro-pediatric, and radiological assessment at inclusion. Eight patients including five with PHACE syndrome were prospectively evaluated.

RESULTS

After a mean follow-up of 8.5 years, three patients presented with an angiomatous aspect of the oral mucosa, two with hearing loss, and two with otoscopic abnormalities. No patients developed ophthalmological abnormalities. The neurological examination was altered in three cases. Brain magnetic resonance imaging follow-up was unchanged in three out four patients and revealed atrophy of the cerebellar vermis in 1 patient. Neurodevelopmental disorders were found in five of the patients and learning difficulties were observed in five patients. The S1 location appears to be associated with a higher risk of neurodevelopmental disorders and cerebellar malformations, while the S3 location was associated with more progressive complications, including neurovascular, cardiovascular, and ENT abnormalities.

CONCLUSION

Our study reported late complications in patients with a large segmental IH of the face or neck, whether associated with PHACE syndrome or not, and we proposed an algorithm to optimize the long-term follow-up.

SARS-CoV-2 seroprevalence and antibodies persistence among health care workers after the first COVID-19 wave in nine hospitals in Western France

Objectives

To estimate the SARS-CoV-2 IgG seroprevalence rate in healthcare workers (HCWs) from Western France after the first 2020 wave, its determinants and the kinetics of total SARS-CoV-2 antibodies.

Patients and methods

Overall, 9,453 HCWs responded to a self-questionnaire and underwent a lateral flow immunoassay to assess SARS-CoV-2 IgG presence. For 72 HCWs who tested positive, total anti-nucleocapsid antibodies were assessed at day 0, 30, and 90.

Results

SARS-CoV-2 IgG seroprevalence rate was 1.06 % [0.86 %–1.27 %]. Factors associated with IgG presence were gender, performing upper respiratory tract samples, contact with HCWs or household members diagnosed with COVID-19. Total antibodies decreased between day 0 and day 90, with anosmia or ageusia, and were higher in HCWs older than 50 years.

Conclusion

We reported a low prevalence rate of IgG and identified several risk factors associated with its presence and persistence of total antibodies. Additional studies are needed to confirm these observations.

Determinants of the willingness to get the third COVID-19 vaccine dose among health care workers

OBJECTIVE

To characterize the willingness to get the third COVID-19 vaccine dose among health care workers (HCWs).

METHODS

A cross-sectional study using a self-administered questionnaire proposed on a voluntary basis to all HCWs of a French teaching hospital in October and November 2021.

RESULTS

Of 1,655 HCWs who completed the questionnaire, 64.2% were willing to receive the third dose, 20.1% were hesitant, and 15.7% were reluctant. On multivariate analysis, older age (P<0.0001), medical and executive staff, willingness to receive the flu vaccine (OR=5.72 [4.24-7.64]), previous vaccine scheme with ChAdOx1 nCoV-19 (AstraZeneca) (OR=2.13 [1.58-2.87]), and history of COVID-19 with a complete COVID-19 vaccine scheme (OR=2.77 [1.04-7.41]) were independent predictors of HCWs' willingness to get the third dose.

CONCLUSIONS

One third of HCWs were hesitant or opposed to a third COVID-19 vaccine dose. Better knowledge of determinants of the willingness to get this third dose may improve communication and vaccine strategy.

POS1234 IMPACT OF THE CHANGE IN ADMINISTRATION ROUTE OF TOCILIZUMAB AND ABATACEPT, DUE TO THE COVID-19 LOCKDOWN ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Among therapeutics used to treat rheumatoid arthritis (RA), Tocilizumab (TCZ) and Abatacept (ABA) are both biologic agents that can be delivered subcutaneously (SC) or intravenously (IV). During the first COVID-19 lockdown in France, all patients treated with IV TCZ or IV ABA were offered the option to switch to SC administration.

Objectives:

The primary aim was to assess the impact of changing the route of administration on the disease activity. The second aim was to assess whether the return to IV route at the patient’s request was associated with disease activity variation, flares, anxiety, depression and low physical activity during the lockdown.

Methods:

We conducted a prospective monocentric observational study. Eligibility criteria: Adult ≥ 18 years old, RA treated with IV TCZ or IV ABA with a stable dose ≥3 months, change in administration route (from IV to SC) between March 16, 2020, and April 17, 2020. The following data were collected at baseline and 6 months later (M6): demographics, RA characteristics, treatment, history of previous SC treatment, disease activity (DAS28), self-administered questionnaires on flares, RA life repercussions, physical activity, anxiety and depression (FLARE, RAID, Ricci &Gagnon, HAD).

The primary outcome was the proportion of patients with a DAS28 variation>1.2 at M6. Analyses: Chi2-test for quantitative variables and Mann-Whitney test for qualitative variables. Factors associated with return to IV route identification was performed with univariate and multivariate analysis.

Results:

Among the 84 patients who were offered to switch their treatment route of administration, 13 refused to change their treatment. Among the 71 who switched (48 TCZ, 23 ABA), 58 had a M6 follow-up visit (13 lost of follow-up) and DAS28 was available for 49 patients at M6. Main baseline characteristics: female 81%, mean age 62.7, mean disease duration: 16.0, ACPA positive: 72.4%, mean DAS28: 2.01, previously treated with SC TCZ or ABA: 17%.

At M6, the mean DAS28 variation was 0.18 ± 0.15. Ten (12.2%) patients had a DAS28 worsening>1.2 (ABA: 5/17 [29.4%] and TCZ: 5/32 [15.6%], p= 0.152) and 19 patients (32.8%) had a DAS28 worsening>0.6 (ABA: 11/17 [64.7%] and TCZ: 8/32 [25.0%], p= 0.007).

At M6, 41 patients (77.4%) were back to IV route (26 TCZ, 15 ABA) at their request. The proportion of patients with a DAS28 worsening>1.2 and>0.6 in the groups return to IV versus SC maintenance were 22.5%, 42.5% versus 11.1% and 22.2% (p=0.4), respectively. The univariate analysis identified the following factors associated with the return to IV route: HAD depression score (12 vs 41, p=0.009), HAS anxiety score (12 vs 41, p=0.047) and corticosteroid use (70% vs 100%, p=0.021), in the SC maintenance vs return to IV, respectively.

Conclusion:

The change of administration route of TCZ and ABA during the first COVID-19 lockdown was infrequently associated with a worsening of RA disease. However, the great majority of the patients (77.4%) request to return to IV route, even without disease activity worsening. This nocebo effect was associated with higher anxiety and depression scores.

Disclosure of Interests:

None declared

The Next Billion Users of Visualization

We argue that visualization research has overwhelmingly focused on users from the economically developed world. However, billions of people around the world are rapidly emerging as new users of information technology. Most of the next billion users of visualization technologies will come from parts of the world that are extremely populous but historically ignored by the visualization research community. Their needs may be different to the types of users that researchers have targeted in the past, but, at the same time, they may have even more to gain in terms of access to data potentially affecting their quality of life. We propose a call to action for the visualization community to identify opportunities and use cases where users can benefit from visualization; develop universal design principles; extend evaluations by including the general population; and engage with a wider global population.

A2A: a platform for research in biomedical literature search

BACKGROUND

Finding relevant literature is crucial for many biomedical research activities and in the practice of evidence-based medicine. Search engines such as PubMed provide a means to search and retrieve published literature, given a query. However, they are limited in how users can control the processing of queries and articles-or as we call them documents-by the search engine. To give this control to both biomedical researchers and computer scientists working in biomedical information retrieval, we introduce a public online tool for searching over biomedical literature. Our setup is guided by the NIST setup of the relevant TREC evaluation tasks in genomics, clinical decision support, and precision medicine.

RESULTS

To provide benchmark results for some of the most common biomedical information retrieval strategies, such as querying MeSH subject headings with a specific weight or querying over the title of the articles only, we present our evaluations on public datasets. Our experiments report well-known information retrieval metrics such as precision at a cutoff of ranked documents.

CONCLUSIONS

We introduce the A2A search and benchmarking tool which is publicly available for the researchers who want to explore different search strategies over published biomedical literature. We outline several query formulation strategies and present their evaluations with known human judgements for a large pool of topics, from genomics to precision medicine.

The impact of social ties and SARS memory on the public awareness of 2019 novel coronavirus (SARS-CoV-2) outbreak

This study examines publicly available online search data in China to investigate the spread of public awareness of the 2019 novel coronavirus (SARS-CoV-2) outbreak. We found that cities that had previously suffered from SARS (in 2003–04) and have greater migration ties to Wuhan had earlier, stronger and more durable public awareness of the outbreak. Our data indicate that 48 such cities developed awareness up to 19 days earlier than 255 comparable cities, giving them an opportunity to better prepare. This study suggests that it is important to consider memory of prior catastrophic events as they will influence the public response to emerging threats.

Image Captioning using Facial Expression and Attention

Benefiting from advances in machine vision and natural language processing techniques, current image captioning systems are able to generate detailed visual descriptions. For the most part, these descriptions represent an objective characterisation of the image, although some models do incorporate subjective aspects related to the observer’s view of the image, such as sentiment; current models, however, usually do not consider the emotional content of images during the caption generation process. This paper addresses this issue by proposing novel image captioning models which use facial expression features to generate image captions. The models generate image captions using long short-term memory networks applying facial features in addition to other visual features at different time steps. We compare a comprehensive collection of image captioning models with and without facial features using all standard evaluation metrics. The evaluation metrics indicate that applying facial features with an attention mechanism achieves the best performance, showing more expressive and more correlated image captions, on an image caption dataset extracted from the standard Flickr 30K dataset, consisting of around 11K images containing faces. An analysis of the generated captions finds that, perhaps unexpectedly, the improvement in caption quality appears to come not from the addition of adjectives linked to emotional aspects of the images, but from more variety in the actions described in the captions.

Association Françoise et Eugène Minkowski – Centre Françoise Minkowska – Parcours de soin et santé mentale

Concernant le parcours de soins en santé mentale « L’objectif est d’améliorer sur le terrain, par des outils et des recommandations de bonne pratique, le parcours de soins et la qualité de vie des personnes présentant des troubles mentaux », précise la direction de l’amélioration de la qualité et de la sécurité des soins de la HAS. Le centre F. Minkowska géré par l’association F. et E. Minkowski a mis en perspective cet objectif pour une population migrante et refugiée afin, d’une part, d’éviter toute ghettoïsation des pratiques cliniques et, d’autre part, le souci de répondre à la demande en proposant une offre de soin tout à fait conforme au droit commun et avec un éclairage santé publique. Le projet d’établissement de ce centre medico-psychosocial s’articule sur la valorisation des bonnes pratiques en les déclinant sur trois volets. Le volet théorique autour des représentations sociales et culturelles de la santé et de la maladie mentale, le volet organisationnel avec la mise en place d’un dispositif (Mediacor) permettant d’améliorer l’accès aux soins pour les personnes migrantes et refugiées et enfin, le volet clinique avec un cadre thérapeutique reposant sur la notion de compétence culturelle. Ces trois aspects permettent de mieux appréhender les obstacles identifiés dans le parcours de soin et, par conséquent, d’y remédier.

AFPS – La psychiatrie sociale : aspects paradigmatiques

Dans ce symposium, nous passerons en revue dans une première partie les références historiques et les paradigmes qui ont sous-tendu les actions complémentaires à la clinique psychiatrique. Dans un deuxième mouvement, la pluridisciplinarité comme principe consolidateur sera formalisée et enfin, il sera fait une place particulière pour l’impact du travail social dans la trame constitutive de la psychiatrie sociale. Il n’est plus contestable actuellement de chercher à évaluer l’impact des déterminants sociaux dans la genèse de la souffrance psychique ou du désordre psychologique. Les références sociales, culturelles et psychologiques s’interpénètrent pour mieux comprendre la systématisation des troubles de la personnalité ou l’apparition de décompensations névrotiques, psychotiques ou psychopathiques. Cette nouvelle approche paradigmatique situe la psychiatrie sociale au carrefour des sciences médicales, humaines et sociales et l’objectif de ce forum est d’engager cette réflexion-reconstruction.

Automated monitoring of tweets for early detection of the 2014 Ebola epidemic

First reported in March 2014, an Ebola epidemic impacted West Africa, most notably Liberia, Guinea and Sierra Leone. We demonstrate the value of social media for automated surveillance of infectious diseases such as the West Africa Ebola epidemic. We experiment with two variations of an existing surveillance architecture: the first aggregates tweets related to different symptoms together, while the second considers tweets about each symptom separately and then aggregates the set of alerts generated by the architecture. Using a dataset of tweets posted from the affected region from 2011 to 2014, we obtain alerts in December 2013, which is three months prior to the official announcement of the epidemic. Among the two variations, the second, which produces a restricted but useful set of alerts, can potentially be applied to other infectious disease surveillance and alert systems.

A French network for prevention and reduction of reproductive risk in couples and pregnant women

Background

Since 2013, several international (ASRM, FIGO, ACOG) and French (ANSES) learned societies and the French National Health and Environment Plan (2015-2019) urged to take into account exposures to environmental reprotoxic substances during standard care of infertile couples and pregnant women. However perinatal health professionals hardly incorporate this recommendation into practice.

Objectives

To create a network of platforms to addressing the environmental aspects that can impact the pregnancy chances of infertile couples after ART and pregnancy outcomes.

We asked regional health authorities in France to provide funding for multidisciplinary hospital structures, in conjunction with clinical-biological reproductive health and gynecology-obstetric centers. Expertise, as well as information leaflets and risk detection tools have been shared.

Results

Platforms of counselling and prevention have been set up in the University Hospitals of Bordeaux, Marseille, Rennes, Créteil and Paris Fernand-Widal. Infertile couples and pregnant women, referred by reproductive physicians, benefit from personalized management of their domestic/professional reprotoxic exposures by addictology/tobacco, dietetics, occupational health and environmental pathology professionals. The network organizes an annual scientific day and a common database of exposure is being set up.

Conclusions

The PREVENIR (PREVENTION - ENVIRONMENT - Reproduction) network of platforms allows perinatal health professionals to refer their patients in order to optimize their chance of pregnancy through personalized and multidisciplinary care. The lifestyle changes initiated through this approach will also improve pregnancy outcomes and child health.

Key messages

A French network for the prevention and reduction of reproductive risk in infertile couples and pregnant women: the PREVENIR platforms (PREVENTION - ENVIRONMENT - Reproduction) is being established. Perinatal health professionals of multidisciplinary platforms engage into preventive actions to limit the exposure to environmental hazards during preconception and pregnancy.

Catering to Your Concerns

Android users are increasingly concerned with the privacy of their data and security of their devices. To improve the security awareness of users, recent automatic techniques produce security-centric descriptions by performing program analysis. However, the generated text does not always address users’ concerns as they are generally too technical to be understood by ordinary users. Moreover, different users have varied linguistic preferences that do not match the text. Motivated by this challenge, we develop an innovative scheme to help users avoid malware and privacy-breaching apps by generating security descriptions that explain the privacy and security related aspects of an Android app in clear and understandable terms. We implement a prototype system, PERSCRIPTION, to generate personalised security-centric descriptions that automatically learn users’ security concerns and linguistic preferences to produce user-oriented descriptions. We evaluate our scheme through experiments and user studies. The results clearly demonstrate the improvement on readability and users’ security awareness of PERSCRIPTION’s descriptions compared to existing description generators.

[Psychological impacts of follow up for occupational asbestos exposure. Consequences after compensation for occupational disease in the SPP-A cohort]

INTRODUCTION

In France, long-term follow-up after occupational exposure to asbestos is recommended. This study looked at the psychological consequences in the longer term following a CT-scan, in particular the impact of having received compensation for an occupational disease.

METHODS

As part of an asbestos post-exposure survey study (APExS), volunteers from Normandy were asked to complete self-assessment questionnaires about their psychological condition at different points during follow-up, including a psychological questionnaire before, then 6 months, and finally 18 to 24 months after their chest CT-scan. Information collected from 622 individuals were analyzed based on information provided as to the result of the screening and whether they had received compensation for having an occupational disease.

RESULTS

The identification of an occupational disease eligible for compensation is associated with a long term increase in psychological distress. The impact of psychological state during follow-up is greater in men who reported receiving occupational disease compensation. The discovery of an asbestos-related disease during the screening is associated with a negative perception of general health and an increase in psychological distress.

CONCLUSION

The receipt of compensation of an occupational disease does not seem to compensate for the negative psychological impact related to the discovery of a disease during the asbestos post-exposure follow-up.

[Guidelines for methacholine provocation testing]

Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The "Lung Function" thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.

A Government-Run Online Community to Support Recipients of Welfare Payments

With the ubiquitous presence of smart phones and the availability of easy-to-use applications, there is an increase in the number of online services. A growing number of people now search for information and interact online. They expect to see services available and accessible online. To meet citizens’ expectations, governments have also increased their online presence. However, information and services are not the only reasons people go online. People also build their social circle online, seeking support and empathy, looking for someone with whom they can talk and who can understand their situation and worries. Online communities (and social networks in general) have been shown to have the potential to provide social and emotional peer-support. Our work aimed at determining whether online communities could be deployed in the public administration domain, in particular to support people receiving welfare payments, with similar benefits. We hypothesized that an online community could provide such support to disadvantaged citizens. Toward testing this hypothesis, after a user requirements analysis and some preparatory work, we designed and developed an online community for a specific target group of welfare recipients, as a collaboration between CSIRO and the Australian Department of Human Services. The community was deployed for one year. In this paper, we briefly explain our aims and the work that went into preparing for the community. We introduce the portal and the support it offered. We then report our observations and findings about both the informational and emotional support participants received, through an analysis of the comments posted in the community, and whether this support was perceived as welcome and useful.

French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial

Essentials An immediate supply of plasma in case of trauma-induced coagulopathy is required. The Traucc trial compared French Lyophilised Plasma (FLyP) and Fresh Frozen Plasma (FFP). FLyP achieved higher fibrinogen concentrations compared with FFP. FLyP led to a more rapid coagulopathy improvement than FFP.

SUMMARY

Background Guidelines recommend beginning hemostatic resuscitation immediately in trauma patients. We aimed to investigate if French lyophilized plasma (FLyP) was more effective than fresh frozen plasma (FFP) for the initial management of trauma-induced coagulopathy. Methods In an open-label, phase 3, randomized trial (NCT02750150), we enrolled adult trauma patients requiring an emergency pack of 4 plasma units within 6 h of injury. We randomly assigned patients to receive 4-FLyP units or 4-FFP units. The primary endpoint was fibrinogen concentration at 45 min after randomization. Secondary outcomes included time to transfusion, changes in hemostatic parameters at different time-points, blood product requirements and 30-day in-hospital mortality. Results Forty-eight patients were randomized (FLyP, n = 24; FFP, n = 24). FLyP reduced the time from randomization to transfusion of first plasma unit compared with FFP (median[IQR],14[5-30] vs. 77[64-90] min). FLyP achieved a higher fibrinogen concentration 45 min after randomization compared with FFP (baseline-adjusted mean difference, 0.29 g L-1 ; 95% confidence interval [CI], 0.08-0.49) and a greater improvement in prothrombin time ratio, factor V and factor II. The between-group differences in coagulation parameters remained significant at 6 h. FLyP reduced fibrinogen concentrate requirements. Thirty-day in-hospital mortality rate was 22% with FLyP and 29% with FFP. Conclusion FLyP led to a more rapid, pronounced and extended increase in fibrinogen concentrations and coagulopathy improvement compared with FFP in the initial management of trauma patients. FLyP represents an attractive option for trauma management, especially when facing logistical issues such as combat casualties or mass casualties related to terror attacks or disasters.

RELN and VLDLR mutations underlie two distinguishable clinico-radiological phenotypes

Pontocerebellar hypoplasias (PCH) are characterized by lack of development and/or early neurodegeneration of cerebellum and brainstem. We report five patients referred for PCH, showing atypical clinical and magnetic resonance imaging (MRI) features suggestive of defects in the Reelin pathway. We screened for mutations in RELN or VLDLR and compared the phenotype of these patients with that of previously reported patients. All patients had profound cerebellar hypoplasia on MRI with peculiar cerebellar morphology, associated with flattened pons and neocortical abnormalities. Patient 1 had profound motor and intellectual disability with moderate lissencephaly suggestive of RELN mutations and was shown to harbor a splicing homozygous RELN mutation. The four other patients had a milder phenotype consistent with CARMQ1 (cerebellar ataxia and mental retardation with or without quadrupedal locomotion). These patients showed mild simplification or thickening of cortical gyration and had VLDLR mutations. Reelin signaling regulates neuronal migration in the developing mammalian brain. VLDLR is a key component of the Reelin pathway. Our patients had a very small and dysplatic cerebellar vermis that should suggest the involvement of these genes. Moreover, differences in clinical severity, involvement of the cerebellar hemispheres, together with the severity of the neocortical defect, enables RELN-mutated patients to be distinguished from VLDLR-mutated patients.

First evidence of occupational asthma to argan powder in a cosmetic factory

BACKGROUND

Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder.

METHODS

Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests, and immunoblotting analysis.

RESULTS

We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts, and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin.

CONCLUSION

High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy, and workers handling argan powder should be carefully investigated.

Photocages for protection and controlled release of bioactive compounds

A photoactivatable ketoprofen–avobenzone dyad was designed for the protection and controlled release of phototoxic drugs.

[Intravenous thrombolysis in ischemic stroke: Therapeutic perspectives]

New therapeutic strategies are under evaluation to improve the treatment of acute ischemic stroke (AIS). Approaches combining intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) and antithrombotic agents are currently evaluated. The combination of IV rt-PA and aspirin showed a high rate of intracranial hemorrhage whereas the association of rt-PA and eptifibatide seems more promising. The results of recent studies evaluating the administration of eptifibatide or argatroban in conjunction with conventional IV thrombolysis with rt-PA are expected to clarify the safety and efficacy of these treatments. More fibrin-specific plasminogen activators, tenecteplase and desmoteplase, are also investigated. These fibrinolytic agents showed a favorable safety profile but their efficacy in AIS remains uncertain. While phase III studies, DIAS-3 and DIAS-4, evaluating IV desmoteplase up to nine hours after stroke onset did not meet the primary endpoint, the results of studies comparing IV tenecteplase and IV rt-PA are expected.

We feel: mapping emotion on Twitter

Research data on predisposition to mental health problems, and the fluctuations and regulation of emotions, thoughts, and behaviors are traditionally collected through surveys, which cannot provide a real-time insight into the emotional state of individuals or communities. Large datasets such as World Health Organization (WHO) statistics are collected less than once per year, whereas social network platforms, such as Twitter, offer the opportunity for real-time analysis of expressed mood. Such patterns are valuable to the mental health research community, to help understand the periods and locations of greatest demand and unmet need. We describe the "We Feel" system for analyzing global and regional variations in emotional expression, and report the results of validation against known patterns of variation in mood. 2.73 ×10(9) emotional tweets were collected over a 12-week period, and automatically annotated for emotion, geographic location, and gender. Principal component analysis (PCA) of the data illustrated a dominant in-phase pattern across all emotions, modulated by antiphase patterns for "positive" and "negative" emotions. The first three principal components accounted for over 90% of the variation in the data. PCA was also used to remove the dominant diurnal and weekly variations allowing identification of significant events within the data, with z-scores showing expression of emotions over 80 standard deviations from the mean. We also correlate emotional expression with WHO data at a national level and although no correlations were observed for the burden of depression, the burden of anxiety and suicide rates appeared to correlate with expression of particular emotions.

Exhaled nitric oxide and screening for occupational asthma in two at-risk sectors: bakery and hairdressing

BACKGROUND

Fractional exhaled nitric oxide (FENO) levels are increasingly being used in the diagnosis and management of asthma. However, this indicator has rarely been used to detect occupational asthma.

OBJECTIVE

To examine non-invasive methods to estimate airway inflammation.

METHODS

A nested case-control study was conducted among a retrospective cohort of young workers in the bakery, pastry-making and hairdressing industries. Subjects underwent a clinical examination during a medical visit. Blood samples were collected and FENO levels measured. Cases were subjects diagnosed as suffering from 'confirmed' or 'probable' occupational asthma.

RESULTS

Of the 178 workers included in the study, 19 were cases. In univariate analysis, FENO was associated with case/control status, and height and smoking status. In a multiple linear regression model, case/control status (P < 0.001), height (P = 0.006) and smoking status (P < 0.001) remained independent risk factors for variations in FENO levels. Good or fair sensitivity of respectively around 80% and 70% can be achieved using low FENO thresholds (8.5 and 10.5 ppb, respectively). FENO >8.5 ppb and a positive clinical examination increases specificity without loss of sensitivity (to 80.5% and 79.0%, respectively).

CONCLUSION

This study suggests that FENO measurements alone cannot be considered a useful screening test for occupational asthma. Further investigations are needed to investigate the use of combined FENO and questionnaire or repeated measures.